Surgical stapler with cartridge-adjustable clamp gap

ABSTRACT

An exemplary surgical apparatus for treating tissue may include an anvil; a jaw pivotally connected to the anvil; and a first cartridge detachably connected to the anvil, holding staples of a first size; where a first clamp gap between the anvil and first cartridge is set by the connection between the first cartridge and jaw. An exemplary cartridge for a surgical stapler may include a cartridge housing; a plurality of staples held within the cartridge housing; and a sled slidable within, and retained by, the cartridge housing, including a central platform, at least one wedge connected to the central platform, and a knife rotatable relative to the central platform.

FIELD OF THE INVENTION

The invention generally relates to surgical staplers and stapling.

BACKGROUND

A linear cutter is a surgical tool that staples and cuts tissue totransect that tissue while leaving the cut ends hemostatic. A typicalendocutter receives at its distal end a disposable single-use cartridgethat holds several rows of staples, and includes an anvil opposed to thecartridge. The cartridge typically includes drivers positioned under thestaples. The surgeon orients the end of the endocutter around the tissueto be transected, and compresses the anvil and cartridge together toclamp the tissue. Then, wedges advance into the cartridge, sequentiallypushing the drivers upward, and the drivers in turn drive the staplesupward against the anvil. Rows of staples are deployed on either side ofthe transection line, and a blade is advanced along the transection lineto divide the tissue. In conventional surgical staplers, it is importantto maintain a substantially constant gap between the anvil and thecartridge for proper staple formation. A staple urged outward from thecartridge or other staple holder is designed to encounter a staplepocket or other feature in the anvil at a certain point in its travel.If the staple encounters that staple pocket or other feature in theanvil too soon or too late, the staple may be malformed. For example, ifthe gap is too large, the staple may not be completely formed. Asanother example, if the gap is too small, the staple may be crushed. Forthis reason, a particular conventional linear cutter can only accept acartridge with a corresponding particular staple size. Inserting intothat linear cutter a cartridge holding larger or smaller staples, ifthat were even possible due to the size differential in the staples andstaple drivers, would cause incomplete formation or malformation ofthose staples.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of an exemplary surgical stapler.

FIG. 2 is a side view of an exemplary end effector of the stapler ofFIG. 1, without a cartridge.

FIG. 3 is a perspective view of the end effector of FIG. 2.

FIG. 4 is a perspective cutaway view of the end effector of FIG. 2,loaded with a blue cartridge.

FIG. 5 is a perspective view of an exemplary blue cartridge.

FIG. 6 is a perspective view of an exemplary white cartridge.

FIG. 7 is a perspective view of an exemplary sled assembly, with a knifein the down position.

FIG. 8 is a perspective view of an exemplary sled assembly, with a knifein the up position.

FIG. 9 is a perspective view of the sled assembly of FIGS. 7-8 in aninitial position in the blue cartridge of FIG. 5.

FIG. 10 is a perspective view of the sled assembly of FIGS. 7-8 in aninitial position in the white cartridge of FIG. 6.

FIG. 11 is a side view of an exemplary anvil.

FIG. 12 is a top view of the anvil of FIG. 11.

FIG. 13 is a perspective view of an exemplary clamp strip.

FIG. 14 is a perspective view of the end effector of FIG. 2, loaded witha blue cartridge of FIG. 5.

FIG. 15 is a detail cutaway perspective view of the end effector of FIG.14.

FIG. 16 is a perspective view of an exemplary jaw of the end effector ofFIG. 2.

FIG. 17 is a detail cutaway side view of the end effector of FIG. 14 ina clamped position.

FIG. 18 is a detail cutaway perspective view of the end effector of FIG.2, loaded with a white cartridge of FIG. 6.

FIG. 19 is a cutaway perspective view of the end effector of FIG. 2 introcar position, loaded with a white cartridge of FIG. 6.

FIG. 20 is a cross-section view of the end effector of FIG. 2 in thetrocar position, loaded with a white cartridge of FIG. 6.

FIG. 21 is a lower perspective view of the end effector of FIG. 2 in anopen position.

FIG. 22 is a side view of the end effector of FIG. 2 in the clampedposition, loaded with a blue cartridge of FIG. 5.

FIG. 23 is a detail cutaway view of the end effector of FIG. 2 showingthe clamp gap.

FIG. 24 is a detail cutaway side view of the end effector of FIG. 14 ina clamped position, loaded with a blue cartridge of FIG. 5, in a stageof deployment.

FIG. 25 is a detail cutaway side view of the end effector of FIG. 24, ina further stage of deployment.

FIG. 26 is a detail cutaway side view of the end effector of FIG. 25, ina further stage of deployment.

FIG. 27 is a side view of the end effector of FIG. 14 in a clampedposition, loaded with a white cartridge of FIG. 6.

FIG. 28 is a detail cutaway side view of the end effector of FIG. 14 ina clamped position, loaded with a white cartridge of FIG. 6.

FIG. 29 is a detail cutaway side view of the end effector of FIG. 14 ina firing position, loaded with a white cartridge of FIG. 6.

The use of the same reference symbols in different figures indicatessimilar or identical items.

DETAILED DESCRIPTION

U.S. Patent Application Publication No. 2009/0065552, published on Mar.12, 2009 (the “Endocutter Document”), is hereby incorporated byreference herein in its entirety.

Referring to FIG. 1, an exemplary surgical stapler 2 may include an endeffector 4 connected to the distal end of a shaft 6. The proximal end ofthe shaft 6 may in turn be connected to a handle 8. The handle 8 mayinclude a single trigger 10. The shaft 6 may be rigid or articulated. Ifthe shaft 6 is articulated, any articulated region may be exposed, ormay be covered with a sleeve or other suitable structure. Referring alsoto FIGS. 2-3, the end effector 4 may include an anvil 12 and a jaw 14.Referring also to FIGS. 4-6, the jaw 14 may be configured to receive atleast one of a blue cartridge 16 and a white cartridge 30. The term“blue cartridge” is standard terminology for a cartridge that firesstaples across a 0.035 inch clamp gap, and the term “white cartridge” isstandard terminology for a cartridge that fires staples across a 0.020inch clamp gap. Advantageously, the jaw 14 is configured to receiveeither cartridge 16, 30, as described in greater detail below.Alternately, the jaw 14 may be configured to receive one or morecartridges having staples of any suitable size.

Referring to FIG. 4, an exemplary blue cartridge 16 is shown, loadedonto the jaw 14. The blue cartridge 16 holds a plurality of staples 18,each frangibly affixed at one end to a corresponding feeder belt 20. Theshape of the staples 18, the configuration of the staples 18 and thefeeder belt 20, and the attachment between the staples 18 and the feederbelt 20 may be substantially as described in the Endocutter Document.Unlike the feeder belt described in the Endocutter Document, the feederbelt 20 of the blue cartridge 16 may be fixed in position relative tothe blue cartridge 16. For example, the blue cartridge 16 may includeone or more rails 22 defined therein, where a feeder belt 20 may beaffixed to the upper surface of each rail 22. In this way, the bluecartridge 16 may be a single-use cartridge, which is replaced after eachfiring. The upper surface 24 of the blue cartridge 16 may include aplurality of apertures 26 defined therethrough, positioned in a way thatcorresponds to the locations of the staples 18 within the blue cartridge16. Additionally, the upper surface 24 of the blue cartridge 16 mayinclude a knife slot 28 through which a knife may slide, as described ingreater detail below. Two rows of apertures 26 may be positioned on eachlateral side of the knife slot 28, allowing two rows of staples 18 to bedeployed therethrough into tissue, as described in greater detail below.As another example, only a single row of apertures 26 may be provided onat least one lateral side of the knife slot 28, allowing a single row ofstaples 18 to be deployed therethrough. As another example, three ormore rows of apertures 26 may be provided on at least one lateral sideof the knife slot 28, allowing three or more rows of staples 18 to bedeployed therethrough. The blue cartridge 16 may include a housing 21that defines a space therein. The upper surface 24 of the blue cartridge16 may have a generally flat region 32 longitudinally extending alongits lateral center, through which the knife slot 28 is defined, and twoangled regions 34 connected to and each extending laterally from thegenerally flat region 32. The apertures 26 may be defined through theangled surfaces 34. The rails 22 defined within the blue cartridge 16may be angled within the blue cartridge 16 in such a manner that therails 22 are substantially perpendicular to the angled regions 34.Alternately, the rails 22 may be angled or oriented in any othersuitable manner. As another example, the upper surface 24 of the bluecartridge 16 need not include angled regions 34, and instead may besubstantially flat along its entirety. As another example of a bluecartridge 16, at least one feeder belt 20 may be configured to advancebetween firings, in a manner such as set forth in co-pending andcommonly-assigned U.S. patent application Ser. No. 12/471,672, filed onMay 26, 2009, which is hereby incorporated by reference in its entirety.As another example of a blue cartridge 16, at least one feeder belt 20may be omitted, and staples 18 that would otherwise have been frangiblyaffixed to that feeder belt 20 may instead be frangibly affixed to theupper surface 24, each adjacent to a corresponding aperture 26, in amanner such as set forth in co-pending and commonly-assigned U.S. patentapplication Ser. No. 12/683,382, filed on Jan. 6, 2010, which is herebyincorporated by reference in its entirety.

The white cartridge 30 may be configured in substantially the same wayas the blue cartridge 16 described above, with three primary exceptions.First, the white cartridge 30 holds smaller staples 18 than are held bythe blue cartridge 16. Second, as a consequence, the white cartridge 30optionally may be shorter than the blue cartridge 16, although thecartridges 16, 30 may have substantially the same longitudinaldimensions as one another. Third, each cartridge 16, 30 includes agap-setting feature that engages with the jaw 14 to set the gap betweenthe anvil 12 and the cartridge 16, 30, and that gap-setting feature islocated at a different location on each cartridge 16, 30. Referring toFIG. 5, on the blue cartridge 16, the blue gap-setting feature 36 may belocated on one or both lateral sides of the blue cartridge 16, near theproximal end of the blue cartridge 16. The blue gap-setting feature 36may be an indentation inward toward the lateral center of the bluecartridge 16, where a portion of the lateral edge of the blue cartridge16 immediately proximal to the blue gap-setting feature 36 is locatedlaterally inward relative to a portion of the lateral edge of the whitecartridge 30 located immediately distal to the blue gap-setting feature36. The blue gap-setting feature 36 may be defined on or near the uppersurface 24 of the blue cartridge 16, but may be positioned differentlyon the blue cartridge 16. The interaction between the blue gap-settingfeature 36 and the jaw 14 that sets the tissue gap is described ingreater detail below. Referring to FIG. 6, on the white cartridge 30,the white gap-setting feature 38 may be located on one or both lateralsides of the white cartridge 30, at the proximal end of the whitecartridge 30. The white gap-setting feature 38 may be located moreproximal on the white cartridge 30 than the blue gap-setting feature 36is located on the blue cartridge 16, where that difference inlongitudinal position differentially engages the jaw 14 to change thetissue gap between the cartridge 16, 30 and the jaw 14 depending on thecartridge 16, 30 loaded onto the jaw 14. The white gap-setting feature38 may be an absence of an indentation, particularly where the whitegap-setting feature 38 is located at the proximal end of the whitecartridge 30, or extends slightly proximal from the proximal end of thewhite cartridge 30. The white gap-setting feature 38 may be defined onor near the upper surface 24 of the white cartridge 30, but may bepositioned differently on the white cartridge 30. The interactionbetween the white gap-setting feature 38 and the jaw 14 that sets thetissue gap is described in greater detail below. Although a bluecartridge 16 and a white cartridge 30 have been described here, other oradditional sizes of cartridge may be fabricated as disclosed above,where differences between the gap-setting features of the cartridgesresults in a difference in tissue gap between the jaw 14 and thecartridge.

Referring to FIG. 7, a sled 40 is slidable along either cartridge 16,30. The sled 40 may include a plurality of wedges 42, and a knife 44that may be pivotable relative to a remainder of the sled 40. Each wedge42 may be shaped in any suitable manner that causes staples 18 contactedby that wedge 42 to first move upward and deform against the anvil 12,then break apart from the feeder belt 20, in a manner such as describedin the Endocutter Document. As one example, the upper surface of atleast one wedge 42 may include a first surface 46 that may be angled orcurved, or both, downwardly in the distal direction. The wedge 42optionally may also include a second surface 48 proximal to the firstsurface 46, where the second surface may be substantially flat.Alternately, the second surface 48 is curved or angled, and/or isincluded as a portion of the first surface. The wedge 42 may include athird surface 50 that may be angled or curved, or both, downwardly inthe distal direction. As described in greater detail below, contactbetween the first surface 46 and a staple 18 bends the staple 18, andcontact between the second surface 50 and the staple 18 breaks off thestaple 18 from the feeder belt 20. The lower surface of the wedge 42 maybe substantially linear.

The wedges 42 may be angled relative to a vertical reference planedefined to pass through both the longitudinal centerline of thecartridge 16, 20 and the knife slot 28 of the cartridge 16, 30. Thisdefinition of “vertical,” and the use of terms such as “vertical,”“horizontal,” “lateral,” “up,”, “down,” “upper,” and “lower,” is solelyfor convenience in describing the surgical stapler 2, and does not limitthe orientation of the surgical stapler 2 in use. The wedges 42 may beangled relative to the reference plane such that the lower surface ofeach wedge 42 is laterally closer to the reference plane than the uppersurface of each wedge 42. The wedges 42 on each side of the referenceplane may be substantially parallel to one another, or may be angledrelative to each other as well. The sled 40 may include a centralplatform 52 that is oriented generally longitudinally. Two wedges 42 maybe attached directly to the central platform 52, one on each lateralside thereof. An outrigger 54 may extend outward from each of thosewedges 42, where each outrigger 54 is in turn connected to a different,further-lateral wedge 42. The central platform 52, wedges 42 andoutriggers 54 may be fabricated as an integral unit, such as by molding,or may be fabricated separately and assembled together at a later time.The central platform 52 may include a fin 66 extending from the proximalend thereof. The fin 66 may extend laterally across less than all of thewidth of the central platform 52, and may be angled such that the bottomof the fin 66 is positioned proximally outward further from the centralplatform 52 than the top of the fin 66. Alternately, the fin 66 may beomitted, or may extend laterally across the entirety of the proximal endof the central platform 52.

The knife 44 may be received in, and rotatable relative to, the centralplatform 52. Advantageously, the knife 44 may be substantially laterallycentered in the central platform 52, such that the knife 44 issubstantially bisected by the reference plane. Referring also to FIG. 9,the central platform 52 may include a knife aperture 56 defined therein.At least part of the knife aperture 56 may extend completely through thecentral platform 52. A pivot axle 58 may extend laterally from the knife44; the axle 58 may be a single rod, or may be defined by two separatepins extending from the knife 44. The pivot axle 58 may be received inan axle receiver 60 defined in the central platform 52, which may bepart of the knife aperture 56 or separate from the knife aperture 56.The pivot axle 58 may be held by the axle receiver 60 in any way thatallows the pivot axle 58 to pivot. The axle receiver 60 may hold thepivot axle 58 laterally and/or longitudinally in a fixed locationrelative to the central platform 52. One or more flip pins 62 also mayextend laterally from the knife 44. The flip pins 62 may be two ends ofa single rod, or two separate pins extending from the knife 44. Asdescribed in greater detail below, the flip pins 62 are used to flip theknife 44 upward from the initial stowed configuration. As seen in FIGS.7-10, the knife 44 may be initially configured in a stowed position. Inthe stowed position, the blade 64 is oriented generally downward, suchthat a user cannot injure himself or herself due to inadvertent contactwith the blade 64.

Referring to FIGS. 9-10, the sled 40 is configured to slide within aremainder of a corresponding cartridge 16, 30. The sled 40 is part ofthe cartridge 16, 30, such that after depletion of the staples 18 in thecartridge 16, 30, the sled 40 is removed from the jaw 14 with thecartridge 16, 30. In this way, the blade 64 of the knife 44 can retainsharpness effectively; in addition, reloading a fresh cartridge 16, 30onto the jaw 14 may be simplified by retaining the sled 40 with theremainder of the cartridge 16, 30. The sled 40 may be held within aremainder of the cartridge 16, 30 by at least one outrigger 54, suchthat the outrigger 54 can only move proximally to a point where itcontacts the outer shell 68 of the cartridge 16, 30. The sled 40 islocated at that most-proximal point in FIGS. 9-10. Alternately, the sled40 may be slidable out of the cartridge 16, 30 prior to exchange of thecartridge 16, 30, such that the sled 40 and knife 44 can be reused withdifferent cartridges 16, 30. Each cartridge 16, 30 may include aplurality of slots 70 along which the wedges 42 slide, and which guidethe wedges 42 to ensure they slide longitudinally along a substantiallylinear path to sequentially engage a plurality of staples 18.

Turning to FIGS. 2 and 11-15, a remainder of the end effector 4 includesthe anvil 12 and the jaw 14. The anvil 12 and the jaw 14 may bepivotally interconnected by two pivot pins 72. The pivot pins 72 may belaterally spaced relative to one another, such that the I-beam,described in greater detail below, is able to advance between them.Alternately, a single pivot pin 72 laterally spanning the end effectormay be utilized. Referring to FIG. 11, each side of the anvil 12 mayinclude a pivot pin receiver 76 defined therein or completelytherethrough, in order to receive the corresponding pivot pin 72therein. In this way, the anvil 12 is pivotable about the lateral axisdefined by the pivot pin receiver 76. The pivot pins 72, and thus thelateral axis defined by the pivot pin receiver 76, may be substantiallyperpendicular to and spaced apart from the longitudinal centerline ofthe cartridge 16. Alternately, the pivot pins 72 and pivot pin receiver76 may be oriented differently relative to one another, and/or thelateral axis defined by the pivot pin receiver 76 may intersect thelongitudinal centerline of the cartridge 16. Referring also to FIG. 12,the anvil 12 may include two spaced-apart legs 78 defining a space 80therebetween. A cam path 82 may be defined in, or completely through,one or both legs 78. The cam path 82 may be configured in any suitablemanner. As one example, the cam path 82 includes a first segment 84 anda second segment 86 proximal to the first segment 84, where the segments84, 86 collectively define a continuous cam path 82. Starting at thedistal end of the cam path 82, the first segment 84 defines a path thatmoves upward in the proximal direction. The first segment 84 may bestraight, curved, or both in combination, or otherwise shaped. Thesecond segment 86 then defines a path that moves downward in theproximal direction. The second segment 86 may be straight, curved, orboth in combination, or otherwise shaped. Turning to FIG. 13, a clampstrip 90 may include a cam pin 92 attached thereto. The clamp strip 90may be a thin, elongated structure that is fabricated from metal or anyother suitable material. The clamp strip 90 may extend through the shaft6 to the handle 8 of the surgical stapler 2. The cam pin 92 may bepositioned at or near the distal end of the clamp strip 90, and may beoriented generally perpendicular to the longitudinal centerline of theclamp strip 90. Alternately, the cam pin 92 may be oriented differentlyrelative to the clamp strip 90. The cam pin 92 may be a single pinstructure, or may be composed of two separate pins, one extending fromeither lateral side of the clamp strip 90. If so, the two separate pinsare advantageously aligned with one another, but need not be. Referringalso to FIGS. 14-15, the cam pin 92 is configured to be received in eachcam path 82 of the anvil 12. The space 80 defined between the legs 78 ofthe anvil 12 receives the distal end of the clamp strip 90.

Referring to FIGS. 14-16, the jaw 14 may include a channel 94 definedgenerally longitudinally along a majority of its length, in its lower,inner surface. At the proximal end of the jaw 14, two jaw walls 96 maybe laterally spaced apart by the channel 95. Each jaw wall 96 mayinclude a cam pin slot 98 defined therein or completely therethrough.Each cam pin slot 98 may be substantially straight and substantiallyparallel to the longitudinal centerline of the jaw 14. Alternately, atleast one cam pin slot 98 may be oriented differently. The cam pin slots98 receive the cam pin 92. Moving from the center laterally outwardtoward one side, the cam pin 92 extends from the clamp strip 90, thenthrough the cam slot 82 on the leg 78 of the anvil 12, then through thecam pin slot 98 in the jaw wall 96. This interaction between the cam pin92, the cam slot 82, and the cam pin slot 98 is used to lock the heightof the anvil 12 relative to the jaw 14, as described below.Additionally, in each jaw wall 96, a pivot pin slot 99 is definedtherein or completely therethrough. The pivot pin slots 99 may besubstantially vertical, and each may be substantially perpendicular tothe cam pin slot 98 defined in the same jaw wall 96. Each pivot pin slot99 is advantageously located distal to and spaced apart from thecorresponding cam pin slot 98 in the same jaw wall 96. Alternately, thepivot pin slots 99 may be located or oriented in any other suitablemanner. The pivot pin slots 99 receive the pivot pins 72.

Referring to FIG. 15, a shuttle 100 is positioned against at least onejaw wall 96. Advantageously, two shuttles 100 are provided, eachassociated with a different jaw wall 96. The shuttle 100 includes acenter aperture 102 that may be generally trapezoidal. The centeraperture 102 may include a lower surface 104, a distal surface 106, anupper surface 108, and a proximal surface 110. The surfaces 104, 106,108, 110 are generally linear, and curve where they intersect. However,the surfaces 104, 106, 108, 110 may be shaped differently and/or mayintersect differently. The lower surface 104 may be generally straightand extend generally longitudinally. The distal surface 106 may begenerally straight, and extend generally vertically and generallyperpendicular to the lower surface 104. The upper surface 108 may begenerally straight, and may be vertically higher at its proximal endthan its distal end. Thus, the proximal end of the upper surface 108 maybe positioned further away from the lower surface 104 than the distalend of the upper surface 108. The proximal surface 110 may be generallystraight, and extend generally vertically and generally perpendicular tothe lower surface 104. Advantageously, the proximal surface 110 islonger than the distal surface 106. Each shuttle 110 may be positionedagainst a shuttle cutout 114 defined in the inner surface of acorresponding jaw wall 96. Each shuttle 100 may include a tail 112extending in the proximal direction within a tail retainer 116 definedin an inner surface of a corresponding jaw wall 96. Each shuttle 100 maybe biased distally, such as by a compression spring wound about acorresponding tail 112. Forward motion of the shuttle 100 as a result ofthe biasing force of the spring 118 may be limited by the distal end ofthe corresponding shuttle cutout 114.

Each pivot pin 72 extends into the center aperture 102 of thecorresponding shuttle 100. Moving from the center laterally outwardtoward one side, the pivot pin 72 extends from the deployment strip 74,then through the pivot pin receiver 76 in the anvil 12, then through thecenter aperture 102 of the shuttle 100, then through the pivot pin slot99 in the jaw wall 96.

Referring to FIG. 17, the deployment strip 74 may be a thin, elongatedstructure that is fabricated from metal or any other suitable material.The deployment strip 74 may extend through the shaft 6 to the handle 8of the surgical stapler 2. A foot 120 may extend downward from thedeployment strip 74, at a location near or at the distal end of thedeployment strip 74. The foot 120 is advantageously wider in the lateraldirection than the deployment strip 74. A pin cutout 122 may be providedat or in proximity to the distal end of the deployment strip 74, at ornear an upper end of the deployment strip 74. The pin cutout 122 mayinclude a first channel 124 and a second channel 126 positioned belowthe first channel 124. The first channel 124 and second channel 126 maybe shaped in substantially the same manner. A detent finger 128separates the channels 124, 126 along the majority of their length. Thedetent finger 128 does not extend all the way to the distal end of thepin cutout 122, and is spaced apart from the distal end of the pincutout 122 by a distance as least as great as the diameter of a crosspin 130. The cross pin 130 extends laterally through the pin cutout 122,but is not fixed to the deployment strip 74. Rather, the cross pin 130is movable within the pin cutout 122, as is described in greater detailbelow. The anvil 12 includes two pin paths 132 defined laterallytherein, spaced apart by a lateral distance at least as great as thelateral thickness of the deployment strip 74. The proximal end of eachpin path 132 may be a pocket 134. The remainder of each pin path 132 maybe a substantially linear travel slot 136 that is connected to andextends distally from the pocket 136. The cross pin 130 is thus slidablealong the pin path 132, and movable within the pin cutout 122, whilebeing trapped by and constrained within the pin path 132 and pin cutout122.

Operation—Inserting Blue Cartridge

Prior to operation of the surgical stapler 2, the user chooses acartridge 16, 30 for insertion into the jaw 14. Referring to FIGS. 2, 4,5 and 15, the user may select a blue cartridge 16. The user then placesthe blue cartridge 16 into the jaw 14. The blue cartridge 16 may befriction-fit into the jaw 14, or may be locked affirmatively into thejaw 14 in any suitable manner. Referring in particular to FIG. 15, asthe blue cartridge 16 is inserted into the jaw 14, each blue gap-settingfeature 36 of the blue cartridge 16 comes into proximity with, and maycontact, the shuttle 100. The shuttle 100 is biased distally, so eachpivot pin 72 may be positioned against the proximal surface 110 of thecenter aperture 102 of the shuttle 100. The end effector 4 may be in theopen position, so each pivot pin 72 is in a higher vertical positionthan when the end effector 4 is in the closed position. Thus, each pivotpin 72 may also be positioned against the upper surface 108 of thecenter aperture 102. As a result, before the blue cartridge 16 is loadedinto the jaw 14, each pivot pin 72 may be positioned in the upperproximal corner of the center aperture 102. When the blue cartridge 16is loaded, its blue gap-setting feature 36 is positioned far enoughdistally that it does not substantially engage the shuttle 100, leavingeach pivot pin 72 in its original position in the upper proximal cornerof the center aperture 102. Referring also to FIG. 4, when each pivotpin 72 is in the upper proximal corner of the center aperture 102, itmay also be positioned at the upper end of the corresponding pivot pinslot 99 defined in the corresponding jaw wall 96.

Referring also to FIG. 17, after the blue cartridge 16 has been insertedinto the jaw 14, the distal end of the deployment strip 74 is inproximity to, or in contact with, the fin 66 of the sled 40.

Operation—Inserting White Cartridge

Prior to operation of the surgical stapler 2, the user chooses acartridge 16, 30 for insertion into the jaw 14. Referring to FIGS. 2, 6,15 and 18, the user may select a white cartridge 30. The user thenplaces the white cartridge 30 into the jaw 14. The white cartridge 30may be friction-fit into the jaw 14, or may be locked affirmatively intothe jaw 14 in any suitable manner. Referring in particular to FIG. 18,as the white cartridge 30 is inserted into the jaw 14, each whitegap-setting feature 38 of the white cartridge 30 contacts thecorresponding shuttle 100 and pushes the corresponding shuttle 100 inthe proximal direction, overcoming the distal bias of the shuttles 100.As with the blue cartridge 16 described above, initially before loadingthe white cartridge 30 each pivot pin 72 is positioned in the upperproximal corner of the center aperture 102 of each shuttle 100. As eachshuttle 100 moves proximally as a result of contact with thecorresponding white gap-setting feature 38, each pivot pin 72 remains insubstantially the same longitudinal position as a consequence ofengagement between each pivot pin 72 and the corresponding pivot pinslot 99 defined in the corresponding jaw wall 96. That is, each pivotpin slot 99 substantially constrains the pivot pin 72 retained thereinagainst longitudinal motion, while allowing vertical motion within theheight defined by the pivot pin slot 99. Thus, as each shuttle 100 movesproximally, while the corresponding pivot pin 72 does not, contactbetween the upper surface 108 of the center aperture 102, which issloped downward toward the distal direction, pushes the pivot pin 72downward. When the white cartridge 30 has been fully inserted into thejaw 14, the white gap-setting features 38 have pushed each shuttle 100proximally to a point at which each pivot pin 72 is located at the upperdistal corner of the center aperture 102 of each shuttle 100. Becausethe distal surface 106 of each center aperture 102 is shorter in heightthan the proximal surface 110 of each center aperture 102, the upperdistal corner of the center aperture 102 of each shuttle 100 is lower inheight than the upper proximal corner of the center aperture 102 of eachshuttle 100. Consequently, insertion of the white cartridge 30 into thejaw 14 has moved the pivot pin 72 lower. When each pivot pin 72 is inthe upper distal corner of the center aperture 102, it may also bepositioned at the lower end of the corresponding pivot pin slot 99defined in the corresponding jaw wall 96.

As described above, the white gap-setting features 38 are located moreproximal on the white cartridge 30 than the blue gap-setting features 36are located on the blue cartridge 16. In this way, engagement betweenthe white cartridge 30 and the shuttles 100 urges the shuttles 100proximally a greater amount than engagement (or affirmativenonengagement) between the blue cartridge 16 and the shuttles 100. Thus,the clamp gap between the anvil 12 and any cartridge inserted into thejaw 14 is set by the longitudinal position of the shuttles 100, whichcontrols the vertical position of the corresponding pivot pins 72. Whenthe pivot pins 72 are set higher by the blue cartridge 16, the clamp gapis set larger to allow thicker tissue to be clamped between the anvil 12and the blue cartridge 16, where the staples 18 held by the bluecartridge 16 are sized to staple tissue of that thickness. When thepivot pins 72 are set lower by the white cartridge 30, the clamp gap isset smaller to allow thinner tissue to be clamped between the anvil 12and the white cartridge 30, where the staples 18 held by the whitecartridge 30 are concomitantly smaller to staple thinner tissue. In thisway, the clamp gap between the anvil 12 and each cartridge 16, 30 isautomatically set to a distance that the staples 18 in the particularcartridge 16, 30 can be deployed across.

The shuttles 100 can be configured to accommodate additional sizes ofcartridges, if desired. As one example, the end effector 4 may alsoaccommodate a green cartridge, which holds larger staples than the bluecartridge 16. The term “green cartridge” is standard terminology for acartridge that fires staples across a 0.050 inch clamp gap. If so, theshuttle 100 may be larger, and the upper surface 108 of the centeraperture 102 of the shuttle 100 may be shaped differently to provide astable position for the corresponding pivot pin 72 between the uppercorners of that center aperture 102. For example, the upper surface 108of the center aperture 102 of each shuttle 100 may be stepped such thatthe corresponding pivot pin 72 may reside at that step in a stablemanner when the blue cartridge 16 is inserted into the end effector; ifso, each pivot pin 72 may be positioned at the upper proximal corner ofthe center aperture 102 of each shuttle 100 when the green cartridge isinserted. Further, in such a situation, the white gap-setting features38 are still located more proximal on the white cartridge 30 than theblue gap-setting features 36 are located on the blue cartridge 16;however, the blue gap-setting features 36 would be located proximallyenough on the blue cartridge 16 to push the shuttles 100 proximallyenough to allow the pivot pins 72 to seat in the steps in the centerapertures 102, and the green gap-setting features would notsubstantially cause the shuttles 100 to move proximally.

When a cartridge 16, 30 is loaded onto the jaw 14, the end effector 4 isadvantageously in an open position, such that the distal end of theanvil 12 is spaced apart from the jaw 14, and such that the anvil 12 ispositioned at an angle relative to the jaw 14. In this way, there issufficient clearance for the user to easily attach a cartridge 16, 30 tothe jaw. In this open position, the clamp strip 90 may be positionedlongitudinally relative to the anvil 12 such that the cam pin 92 islocated at the proximal end of each first segment 84 of the cam path 82defined in each leg 78 of the anvil 12. Alternately, the cam pin 92 maybe positioned differently relative to the cam paths 82 defined in thelegs 78 of the anvil 12.

Operation—Trocar Position

After a cartridge 16, 30 has been loaded onto the jaw 14, the surgicalstapler 2 is ready for firing. The surgical stapler 2 may be used in aminimally-invasive procedure, where it is inserted through a trocar portinto a patient's body. If so, it is advantageous to minimize thecross-sectional area of the end effector 4 during insertion into thepatient in order to minimize the size of the trocar port that must beinserted into the patient's body. The minimum cross-sectional areaposition of the end effector 4 is defined as the “trocar position.” Inthe trocar position, the end effector 4 advantageously has across-sectional area that is at least as small as that of the shaft 6,and additionally does not extend radially from the longitudinalcenterline of the shaft 6 a distance greater than the outer surface ofthe shaft 6. As one example, the shaft 6 is five millimeters indiameter, such that the radius from the longitudinal centerline of theshaft 6 to the outer surface of the shaft 6 is 2.5 millimeters. Introcar position, the end effector 4 would assume a configuration suchthat all portions of the end effector 4 would be positioned radiallywithin 2.5 millimeters of the longitudinal centerline of the shaft 6. Asanother example, the trocar position of the end effector 4 may result inthe end effector 4 having a cross-sectional area that is larger thanthat of the shaft 6, or extending radially from the longitudinalcenterline of the shaft 6 a distance greater than the outer surface ofthe shaft 6. The trocar position of the end effector 4 is advantageouslya configuration of the end effector 4 in which the end effector 4 has asmaller cross-sectional area than a clamped configuration of the endeffector 4. Further, in the trocar position, advantageously there issubstantially no gap between the anvil 14 and the cartridge 16, 30 alonga substantial length of the cartridge 16, 30. Optionally, a gap maystill remain between the anvil 14 and the cartridge 16, 30 in trocarposition.

The end effector 4 may be moved to the trocar position in any suitablemanner. Referring also to FIGS. 19-20, as one example, to move the endeffector 4 to the trocar position, the clamp strip 90 is advanceddistally. The clamp strip 90 may be advanced distally in any suitablemanner, such as by a force transmitted from the handle 8. As the clampstrip 90 advances distally, the cam pin 92 fixed to the clamp strip 90advances distally as well. As the cam pin 92 advances distally, the campin 92 moves distally within each cam path 82 defined in each leg 78 ofthe anvil 12. Distal motion of the cam pin 92 moves the cam pin 92within the first segment 84 of each cam path 82, which is orienteddownward in the distal direction. Further, the cam pin 92 is constrainedto move linearly and longitudinally by the cam pin slots 98 defined inthe jaw 14. Consequently, as the cam pin 92 moves distally within thecam pin slots 98, the orientation of the first segment 84 of each campath 82 defined in the anvil 12 causes the cam pin 92 to push the anvil12 downward at the point of contact between the cam pin 92 and the anvil12. As the anvil 12 is pushed downward, each pivot pin 72 is pusheddownward within the center aperture 102 of the corresponding shuttle100. Each pivot pin 72 may be pushed downward until it encounters thelower surface 104 of the center aperture 102. Alternately, at least onepivot pin 72 does not move downward a sufficient amount to encounter thelower surface 104 of the center aperture 102. Thus, when the endeffector 4 is in the trocar position, each pivot pin 72 may bepositioned in the lower distal corner of the center aperture 102 of eachshuttle 100.

Referring also to FIG. 21, the anvil 12 may include a tissue stop 138extending downward therefrom, at a location distal to the pivot pins 72.Referring also to FIG. 10, as the end effector 4 moves from the openposition to the trocar position, the anvil 12 moves downward relative tothe cartridge 16, 30 and the jaw 14. As the anvil 12 moves downward, thetissue stop 138 moves downward as well. As the tissue stop 138 continuesto move downward, the tissue stop 138 may enter a space 140 defined inthe proximal end of the cartridge 16, 30, where the space 140 is presentto accommodate the tissue stop 138. As the tissue stop 138 continues tomove downward, the tissue stop 138 encounters, and begins to exert adownward force upon, at least one flip pin 62 attached to the knife 44.The tissue stop 138 may be longitudinally bisected by a slot 142 that isat least as wide as the knife 44, such that a portion of the knife 44can be received in the slot 142 as the tissue stop 138 continues to movedownward. Because the flip pins 62 are located proximal to the pivotaxle 58 of the knife 44, and the pivot axle 58 is fixed relative to thesled 40, the downward force exerted by the tissue stop 138 on the flippins 62 flips the knife 44 up to a cutting position by rotating the flippins 62 downward and proximally. The flip pins 62 may continue theirrotation until encountering a surface of the sled 40, where thatencounter prevents further rotation.

After the end effector 4 has been inserted into the patient, it isreturned to the open position. The end effector 4 may be opened after ithas been moved to the surgical space, or may be opened upon entry intothe patient, at the discretion of the user. As can also been seen inFIG. 21, the anvil 12 pivots about a point substantially distal to itsproximal end. The longitudinal distance between the proximal end of theanvil 12 and the point at which the anvil 12 pivots relative to the jaw14 may be at least as long as the cam pin slots 98 defined in the jaw14. The pivot pins 72 may be positioned substantially one-quarter of thelength of the anvil 12 distally from the proximal end of the anvil 12.Further, in the open position, the legs 78 of the proximal end of theanvil 12 may protrude beneath the bottom of the jaw 14. An anvilaperture 158 may be defined through the lower surface of the jaw 14 inorder to allow the proximal end of the anvil 12 to move therethrough andreach a position underneath the bottom of the jaw. In order to returnthe end effector 4 from the trocar position to the open position, theclamp strip 90 may be moved proximally, substantially to the position ithad occupied when the cartridge 16, 30 was loaded onto the jaw 14. As aresult, the clamp pin 92 moves proximally within each of the cam pinslots 98 in the jaw, and proximally within the cam paths 82 defined inthe anvil 14. The consequence of this motion is substantially thereverse of the previous distal motion of the clamp pin 92 within the campin slots 98 and cam paths 82. As the cam pin 92 moves proximally withinthe cam pin slots 98, the orientation of the first segment 84 of eachcam path 82 defined in the anvil 12 causes the cam pin 92 to pull theanvil 12 upward at the point of contact between the cam pin 92 and theanvil 12. As the anvil 12 is pulled upward, each pivot pin 72 is pusheddownward within the center aperture 102 of the corresponding shuttle100. Each pivot pin 72 may be pulled upward until it encounters theupper surface 108 of the center aperture 102. Alternately, at least onepivot pin 72 does not move upward a sufficient amount to encounter theupper surface 108 of the center aperture 102. Thus, when the endeffector 4 is in the open position, each pivot pin 72 may be positionedin the upper distal corner of the center aperture 102 of each shuttle100, in the position it had previously occupied when the end effector 4was in the open position during loading of the cartridge 16, 30.

When the end effector 4 returns to the open position, the knife 44remains in the flipped-up position, and is ready to cut tissue. Theknife 44 remains in the flipped-up position because no force acts uponit to push it back to its down position. The pivot axle 58, and/or otherportion of the knife, may be configured to have a small degree offrictional resistance to motion, in order to prevent the knife 44 frommoving out of the flipped-up position as a result of the action ofgravity or as a result of the user changing the orientation of the endeffector 4. A detent or other mechanism or structure may instead be usedto ensure that the knife remains in the flipped-up position during thetransition of the end effector 4 from the trocar position to the openposition.

Operation—Clamping

The user then places the end effector 4 about tissue to be treated, suchthat tissue is positioned between the anvil 12 and the cartridge 16, 30.Once the user is satisfied with the position of the end effector 4relative to tissue, the user may clamp the end effector. Referring alsoto FIG. 22, as one example, in order to move from the open position to aclamped position, the clamp strip 90 is moved proximally. The clampstrip 90 may be retracted proximally in any suitable manner, such as bya force transmitted from the handle 8. As the clamp strip 90 retractsproximally, the cam pin 92 fixed to the clamp strip 90 retractsproximally as well. As the cam pin 92 retracts proximally, the cam pin92 moves proximally within each cam path 82 defined in each leg 78 ofthe anvil 12. Proximal motion of the cam pin 92 moves the cam pin 92within the second segment 86 of each cam path 82, which is orienteddownward in the proximal direction. Further, the cam pin 92 isconstrained to move linearly and longitudinally by the cam pin slots 98defined in the jaw 14. Consequently, as the cam pin 92 moves proximallywithin the cam pin slots 98, the orientation of the second segment 86 ofeach cam path 82 defined in the anvil 12 causes the cam pin 92 to liftthe anvil 12 upward at the point of contact between the cam pin 92 andthe anvil 12. As the proximal end of the anvil 12 is lifted upward, eachpivot pin 72 experiences a force that urges that pivot pin 72 upward.However, each pivot pin 72 is already positioned against the uppersurface 108 of the center aperture 102 of the corresponding shuttle 100,whether in the upper, distal corner of the center aperture 102 where thewhite cartridge 30 is loaded, or in the upper, proximal corner of thecenter aperture 102 where the blue cartridge 16 is loaded. Consequently,as the proximal end of the anvil 12 is lifted by the cam pin 92, theshuttles 100 provide a downward constraint on the anvil 12. As a result,the anvil 12 pivots about the pivot pins 72 as the proximal end of theanvil 12 is lifted. Thus, referring to FIG. 22, if no tissue werepositioned between the anvil 12 and the cartridge 16, 30, then the anvil12 would be angled forward, such that the distal end of the anvil 12would be closer to the cartridge 16, 30 than the portion of the anvil 12adjacent to the pivot pins 72. This angle of the anvil 12 compensatesfor deflection of the anvil 12 under tissue loading. Deflection of acantilever such as the anvil 12 increases with distance from the pivotpoint, such that angling the anvil 12 forward as shown in FIG. 22results in an anvil 12 that is substantially parallel to the cartridge16, 30 when tissue is present between the anvil 12 and the cartridge 16,30.

The end effector 4 has reached the clamped position after the cam pin 92has reached the proximal end of the second segment 86 of the cam paths82 in the anvil 12, such that it cannot move further proximally.Alternately, the tissue thickness may be such that the cam pin 92 onlymoves partially along the second segment 86 before it can no longeradvance, due to the force needed to further compress the tissue beinggreater than the force that can be exerted by the cam pin 92. After thetissue has been clamped, the surgical stapler 2 is ready to fire.Optionally, a locking feature may be provided in the handle 8 orelsewhere to ensure that the end effector 4 remains locked. Such lockingmay be performed at the discretion of the user, or automatically, suchas by immobilizing the clamp strip 90 to prevent it from moving afterthe end effector 4 reaches the clamped position. In the clampedposition, the presence of a clamp gap between the anvil 12 and thecartridge 16, 30 means that the cross-sectional area of the end effector4 in the clamped position is greater than the cross-sectional area ofthe end effector 4 in the trocar position.

Operation—Blue Cartridge

For the blue cartridge 16, the end effector 4 has reached the clampedposition after the cam pin 92 has reached the proximal end of the secondsegment 86 of the cam paths 82 in the anvil 12, such that it cannot movefurther proximally. Alternately, the cam pin 92 may only move partiallyalong the second segment 86 before it can no longer advance, due to theforce needed to further compress the tissue being greater than the forcethat can be exerted by the cam pin 92. After the tissue has beenclamped, the surgical stapler 2 is ready to fire. Optionally, a lockingfeature may be provided in the handle 8 or elsewhere to ensure that theend effector 4 remains locked. Such locking may be performed at thediscretion of the user, or automatically, such as by immobilizing theclamp strip 90 to prevent it from moving after the end effector 4reaches the clamped position.

The staples 18 in the blue cartridge 16 are designed to operate mostefficaciously when deployed across a clamp gap of generally 0.035inches. Referring also to FIG. 23, the clamp gap 144 is defined as thespace between the anvil 12 and the cartridge 16, 30, measuredlongitudinally at the distal end of the tissue stop 138. The location ofmeasurement is specified due to the fact that the anvil 12 anglesdownward in the distal direction in the absence of tissue, as describedabove. Thus, when the blue cartridge 16 is positioned in the jaw 14, theclamp gap 144 is advantageously substantially 0.035 inches. The clampgap 144 is controlled by the position of the shuttles 100. As set forthabove, when the blue cartridge 14 is loaded into the jaw 14, each pivotpin 72 is located in the upper, proximal corner of the center aperture102 of the corresponding shuttle 100. This height of the pivot pins 72results in an angle of the anvil 12 downward in the distal directionsuch that the clamp gap 144 measured at the distal end of the tissuestop 138, which is distal to the pivot pins 72, is the appropriateamount of 0.035 inches for a blue cartridge 16. At that height, eachpivot pin 72 may be located at or near the upper end of thecorresponding pivot pin slot 99 in the jaw 14. Alternately, at least onepivot pin 72 may be spaced downwardly from the upper end of thecorresponding pivot pin slot 99 in the jaw 14.

Referring also to FIG. 17, in order to deploy staples 18 from the bluecartridge 16, the deployment strip 74 is advanced distally. The crosspin 130, held by the detent finger 128, is advanced distally with thedeployment strip 74. Due to the spacing between the anvil 12 and theblue cartridge 16 set by the shuttles 100, the cross pin 130 is atsubstantially the same height relative to the blue cartridge 16 as thetravel slots 136. That is, the cross pin 130 is in vertical alignmentwith the travel slots 136. As a result, as the cross pin 130 advancesdistally, it slides into the travel slots 136, held by the detent finger128.

Referring also to FIG. 8, in addition, as the deployment strip 74advances distally, the deployment strip 74 contacts the fin 66 of thesled 40, and thereby pushes the sled 40 distally. As the sled 40advances distally, the wedges 42 and knife 44 advance distally. Eachwedge 42 contacts, deforms, and then shears from the feeder belt 20 oneor more staples 18, in a linearly sequential manner. Each wedge 42directly contacts one or more staples 18, without the need for anintermediate staple driver between the wedge 42 and any staple 18.Deformation of the staples 18 and subsequent breaking off of thosestaples 18 from the corresponding feeder belt 20 may be performedsubstantially as set forth in the Endocutter Document. The knife 44 maybe positioned proximal to one or more wedges 42, such that staples 18are sequentially deployed before the stapled tissue is cut by the blade64 of the knife 44. Alternately, the knife 44 may be positioneddifferently on the sled 40 such that the blade 64 cuts tissue at adifferent time relative to stapling.

Referring also to FIG. 24, as the deployment strip 74 advances, thecross pin 130 continues to advance distally along the travel slots 136.Additionally, the foot 120, which is attached to the deployment strip74, advances distally with the deployment strip 74. The foot 120 mayslide along a channel 148 defined in an undersurface of the jaw 14, suchthat the bottom of the foot 120 is substantially flush with theundersurface of the jaw 14, or may simply slide along the undersurfaceof the jaw 14. In either case, the foot 120 travels distally at a heightthat is substantially the same along the entire distance of travel ofthe deployment strip 74. The combination of the cross pin 130 held inthe travel slots 136 and by the deployment strip 74, and the foot 120extending from the deployment strip 74 and sliding along a definedsurface on the jaw 14, provides additional localized clamping betweenthe cross pin 130 and the foot 120 as the deployment strip 74 advances.Because the foot 120 is constrained to travel along a longitudinal pathdefined by the channel 148 or the underside of the jaw 14, in order forthe cross pin 130 to continue moving forward into the travel slots 136,the cross pin 130 must exert a downward force against the lower surfacesof the travel slots 136, locally increasing compression as necessary inorder to counteract any bending of the anvil 12 as a result ofcompression of tissue between the anvil 12 and the blue cartridge 16.

Referring also to FIG. 25, as the deployment strip 74 nears the end ofits travel distally, the knife 44 begins to rotate back downward to itsdown position. Previously, the bottom of the knife 44 slid along theknife slot 150 defined in an undersurface of the jaw 14. The knife slot150 may be defined completely through the undersurface of the jaw 14, ormay simply be a recess within the jaw 14. As the deployment strip 74nears the end of its travel, the bottom of the knife 44 contacts thedistal end 152 of the knife slot 150. This contact occurs below thepivot axle 58 of the knife 44, thereby causing the knife 44 to rotateabout the pivot axle 58 distally and downwardly. As the knife 44 rotatesdown and distally, it makes a final cut to tissue with a “karate chop”motion, if tissue is located at that position relative to the knife 44.Referring also to FIG. 26, the deployment strip 74 continues to advance,pushing the sled 40 and the knife 44 distally. The knife 44 has reachedthe down position, and is located within a parking space 154 definedwithin, and at or near the distal end of, the blue cartridge 16. In thisway, after use the knife 44 is securely stowed in a manner in which itcannot cause inadvertent injury to the user. Advantageously, the sled 40is frictionally locked into engagement, or otherwise affirmativelylocked into engagement, with the parking space 154 such that the knife44 is securely held inside the parking space 154. The deployment strip74 may continue advancing distally until the cross pin 130 encountersthe distal end of the travel slots 136, which stops further distalmotion of the deployment strip 74. Alternately, or in addition, the foot120 may encounter a foot stop 160 defined in the jaw 14, such as at thedistal end of the channel 148, such that contact between the foot stop160 and the foot 120 prevents further distal motion of the deploymentstrip 74. Alternately, the deployment strip 74 may be controlled by thehandle 8 or in another manner to travel through a stroke and stop at alocation that is defined other than by encountering a physical stoppoint that provides a barrier to further distal motion.

The tissue between the anvil 12 and blue cartridge 16 has now beenstapled by staples 18 and divided by the knife 44. The deployment strip74 is then moved proximally. The sled 40 is held in the parking space154, and remains in the parking space 154 as the deployment strip 74moves proximally to its initial location. The cross pin 130 movesproximally out of the travel slots 136 and into the pockets 134. At thattime, the cross pin 130 and foot 120 no longer provide additionalclamping to the end effector 4. The end effector 4 can then be unclampedin the reverse of the manner in which it was clamped. The clamp strip 90is moved distally, and the concomitant distal motion of the cam pin 92moves the cam pin 92 distally within the second segment 86 of each campath 82, which is oriented downward in the proximal direction. Further,the cam pin 92 is constrained to move linearly and longitudinally by thecam pin slots 98 defined in the jaw 14. Consequently, as the cam pin 92moves distally within the cam pin slots 98, the orientation of thesecond segment 86 of each cam path 82 defined in the anvil 12 causes thecam pin 92 to push the anvil 12 downward at the point of contact betweenthe cam pin 92 and the anvil 12. As the proximal end of the anvil 12 ispushed downward, each pivot pin 72 experiences a force that urges thatpivot pin 72 upward. The end effector 4 thus returns to the openposition.

After the end effector 4 has been opened, the user can remove the spentblue cartridge 16. The sled 40, including the knife 44, is part of thespent blue cartridge 16, and is disposable along with the remainder ofthe spent blue cartridge 16. At that time, if the user wishes to performfurther treatment of the patient, the user can insert a blue cartridge16 or a white cartridge 30 into the jaw 14 of the end effector 4.

Operation—White Cartridge

Referring also to FIG. 27, the cam pin 92 need not travel proximally asfar to clamp a white cartridge 30 as a blue cartridge 16. This isbecause the tissue to be clamped when a white cartridge 30 is used isthinner than the tissue clamped when a blue cartridge 16 is used, sothat less force is necessary to effectuate clamping. The cam pin 92 neednot travel completely to the proximal end of the second segment 86 ofthe cam paths 82 in the anvil 12, or the proximal ends of the cam pinslots 98 in the jaw 14, in order for the end effector to reach theclamped position when a white cartridge 30 is in place in the jaw 14.Alternately, the cam pin 92 may move completely the proximal end of thesecond segment 86 of the cam paths 82 in the anvil 12, and/or theproximal ends of the cam pin slots 98 in the jaw 14, to effectuateclamping where a white cartridge 30 is loaded into the jaw 14. Asanother example, it may be desirable for the cam pin 92 to move a fixedamount proximally each time clamping is performed in order to simplifyconstruction and operation of the surgical stapler 2. If so, apre-loaded compression spring (not shown) may be connected to the clampstrip 90, where the compression loaded is equal to the desired maximumtissue pressure to be exerted by the end effector 4 in clamped position.Further motion of the cam pin 92 proximally, after that force has beenreached, is taken up by the spring, which absorbs the “extra” stroke ofthe clamp strip 90. In this way, the end effector 4 is clamped to apredetermined force, rather than clamped to the position of the cam pin92 within the end effector 4. After the tissue has been clamped, thesurgical stapler 2 is ready to fire. Optionally, a locking feature maybe provided in the handle 8 or elsewhere to ensure that the end effector4 remains locked. Such locking may be performed at the discretion of theuser, or automatically, such as by immobilizing the clamp strip 90 toprevent it from moving after the end effector 4 reaches the clampedposition.

Referring also to FIG. 23, the staples 18 in the white cartridge 30 aredesigned to operate most efficaciously when deployed across a clamp gap144 of generally 0.020 inch. The clamp gap 144 is controlled by theposition of the shuttles 100. As set forth above, when the whitecartridge 30 is loaded into the jaw 14, each pivot pin 72 is located inthe upper, distal corner of the center aperture 102 of the correspondingshuttle 100. This height of the pivot pins 72 results in an angle of theanvil 12 downward in the distal direction such that the clamp gap 144measured at the distal end of the tissue stop 138, which is distal tothe pivot pins 72, is the appropriate amount of 0.020 inches for a bluecartridge 16. In this way, the cartridges 16, 30 each set a discreteclamp gap 144, such that the end effector 4 is configured to provide atleast two discrete clamp gaps 144. Further, that height of each pivotpin 72 may place it substantially in the middle of the correspondingpivot pin slot 99. Alternately, at least one pivot pin 72 may bepositioned against the lower end of the pivot pin slot 99 in the clampedposition. In the clamped position, the height of each pivot pin 72 whenthe white cartridge 30 is used is lower than the height of each pivotpin 72 when the blue cartridge 16 is used.

Referring also to FIG. 28, in order to deploy staples 18 from the whitecartridge 30, the deployment strip 74 is advanced distally. The crosspin 130, held by the detent finger 128, is advanced distally with thedeployment strip 74. Due to the spacing between the anvil 12 and thewhite cartridge 30 set by the shuttles 100, the cross pin 130 is locatedhigher relative to the white cartridge 30 as the travel slots 136. Thatis, the cross pin 130 is out of vertical alignment with the travel slots136. As a result, as the cross pin 130 advances distally, it encountersthe front wall 156 of each pocket 134. Continued motion distally of thedeployment strip 74 thereby forces the cross pin 130 against the frontwall 156, consequently forcing the cross pin 130 off of the detentfinger 128 and into the first channel 124. As the deployment strip 74continues to move distally, the cross pin 130 continues to slide intothe first channel 124. The first channel 124 is oriented longitudinally,and downward in the longitudinal direction. Thus, the cross pin 130continues to slide relative to the first channel 124 until the cross pin130 is vertically aligned with the travel slots 136. At that time,further distal motion of the deployment strip 74 urges the cross pin 130into the travel slots 136. Referring also to FIG. 29, the first channel124 may be configured such that the proximal end of the first channel124 is at substantially the same height relative to the white cartridge30 as the travel slots 136, such that the cross pin 130 is located atthe proximal end of the first channel 124 when the cross pin 130 isvertically aligned with the travel slots 136. This ability of the crosspin 130 to change vertical height depending on the clamp gap 144 set bythe inserted cartridge 16, 30 allows the end effector 4 to clampeffectively at two or more discrete clamp gaps 144.

Deployment of staples 18 from the white cartridge 30 is performedsubstantially as described above with regard to the blue cartridge 16,and in the Endocutter Document. Advancement of the deployment strip 74pushes the sled 40 distally, which in turn deforms staples 18, breaksstaples 18 from the corresponding feeder belt 20, and cuts the stapledtissue held between the anvil 12 and the white cartridge 30. Continuedadvancement of the deployment strip 74 completes a firing stroke, afterwhich the knife 44 enters the parking space 154 at the distal end of thewhite cartridge 30. The deployment strip 74 may then be retractedproximally and the end effector 4 unclamped and returned to the openposition, at which time the user can remove the spent white cartridge30. The sled 40, including the knife 44, is part of the spent whitecartridge 30, and is disposable along with the remainder of the spentwhite cartridge 30. If the user wishes to perform further treatment ofthe patient, the user can insert a blue cartridge 16 or a whitecartridge 30 into the jaw 14 of the end effector 4.

Manual Clamp Gap Setting

As another example of the end effector 4, the clamp gap 144 optionallymay be set manually, rather then automatically. By way of example, theshuttles 100 may be movable longitudinally as a result of manualintervention. A cable, rod, strip or other structure may extend from theshuttles 100 to the handle 8, such that the user can adjust thelongitudinal position of the shuttles 100 by way of manual input to thehandle 8. As another example, the longitudinal position of the shuttles100 may be set by way of a switch, such as a slider, on the end effector4 itself. Where the clamp gap 144 is set manually, the gap-settingfeatures 36, 38 may be omitted from the cartridges 16, 30.

While the invention has been described in detail, it will be apparent toone skilled in the art that various changes and modifications can bemade and equivalents employed, without departing from the presentinvention. It is to be understood that the invention is not limited tothe details of construction, the arrangements of components, and/or themethod set forth in the above description or illustrated in thedrawings. Statements in the abstract of this document, and any summarystatements in this document, are merely exemplary; they are not, andcannot be interpreted as, limiting the scope of the claims. Further, thefigures are merely exemplary and not limiting. Topical headings andsubheadings are for the convenience of the reader only. They should notand cannot be construed to have any substantive significance, meaning orinterpretation, and should not and cannot be deemed to indicate that allof the information relating to any particular topic is to be found underor limited to any particular heading or subheading. Therefore, theinvention is not to be restricted or limited except in accordance withthe following claims and their legal equivalents.

What is claimed is:
 1. A surgical apparatus for treating tissue,comprising: an anvil; a jaw pivotally connected to said anvil; a firstcartridge detachably connected to said anvil, said first cartridgeholding staples of a first size and including a first gap-settingfeature defined in an exterior of the first cartridge, wherein a firstclamp gap between said anvil and said first cartridge is set by saidgap-setting feature; and at least one shuttle held by said jaw, whereinsaid shuttle is biased distally and slidable longitudinally, and whereinsaid shuttle is configured to engage said gap-setting feature when saidfirst cartridge is inserted into said jaw.
 2. The surgical apparatus ofclaim 1, further comprising a second cartridge detachably connected tosaid anvil, said second cartridge holding staples of a second size andincluding a second gap-setting feature defined in an exterior of thesecond cartridge, wherein a second clamp gap between said anvil and saidsecond cartridge is set by said second gap-setting feature, and whereinsaid first clamp gap is different from said second clamp gap.
 3. Thesurgical apparatus of claim 2, wherein said first gap-setting feature islocated further proximal in the first cartridge than the secondgap-setting feature is located in said second cartridge.
 4. The surgicalapparatus of claim 1, wherein said shuttle comprises a central aperturewith a greater height at its proximal end than its distal end.
 5. Thesurgical apparatus of claim 4, further comprising at least one pivot pinconstrained within and movable within said central aperture of acorresponding said shuttle, wherein each said pivot pin interconnectssaid anvil and said jaw.
 6. The surgical apparatus of claim 5, furthercomprising at least one pivot pin slot defined in said jaw within whicha corresponding said pivot pin is slidable, wherein said pivot pin slotis substantially linear and oriented substantially vertically.
 7. Thesurgical apparatus of claim 6, wherein engagement between each saidgap-setting feature and a corresponding said shuttle pushes said shuttleproximally, such that each corresponding said pivot pin moves to theupper distal corner of said central aperture of said shuttle.
 8. Thesurgical apparatus of claim 1, further comprising a deployment slideslidable longitudinally into and within said first cartridge, whereinsaid deployment slide includes a foot slidable along an outer surface ofsaid jaw, a pin cutout having a first channel defined therein; a detentfinger under said first channel, and a cross pin held within said pincutout, wherein said cross pin is movable between a first position inwhich said cross pin is held by said detent finger and a second positionin which said cross pin is held within said first channel.
 9. Thesurgical apparatus of claim 8, further comprising a sled that includes aplurality of wedges and a rotatable knife, wherein said deployment slideis positioned proximal to said sled such that distal sliding of saiddeployment slide pushes said sled distally; wherein distal motion ofsaid sled causes said wedges to contact said staples directly to deploysaid staples, and additionally causes said knife to cut tissue.
 10. Thesurgical apparatus of claim 1, further comprising: a clamp slideslidable longitudinally within said jaw; a clamp pin fixed to said clampside; at least one cam path defined in said anvil, within which said campin is slidable; and at least one cam pin slide defined in said jaw,within which said cam pin is slidable; wherein longitudinal motion ofsaid clamp pin in a first direction causes said anvil to move from anopen position to a closed position.
 11. The surgical apparatus of claim10, wherein each said cam pin slide is substantially linear and orientedsubstantially longitudinally.
 12. The surgical apparatus of claim 10,wherein said anvil includes two laterally-spaced legs, each of whichincludes one said cam path defined therein.
 13. The surgical apparatusof claim 10, wherein longitudinal motion of said clamp pin in a seconddirection causes said anvil to move from an open position to a trocarposition.